Faecal Occult Blood Testing (FOBT) Explanation – OSCE guide

Finding blood in the stool is always abnormal and should be evaluated by a medical professional as soon as possible. The faecal occult blood test (FOBT) is used to determine the presence of blood in the stool.


There may be blood in the stool for a number of reasons including:

  • Bowel cancer
  • Crohn’s disease
  • Ulcerative colitis
  • Gastroenteritis
  • Anal fissures
  • Haemorrhoids


In many countries around the world, the FOBT is part of national screening programs which have been shown to be effective in identifying individuals at increased risk of disease.

Early detection can ensure effective treatment, prevent disease progression and reduce morbidity. In the United Kingdom screening is recommended every two years for men and women aged between 60 and 74 and in those patients with a family history of colorectal carcinomas. In the future, the United Kingdom screening program will introduce flexible sigmoidoscopies, for those over the age of 55, alongside home FOBT.

It is worth noting that screening guidelines and the type of test used differ between countries and as such local guidelines should be consulted.


FOBT counselling

Opening the consultation

  • Introduce yourself
  • Confirm the patient’s name and date of birth


Explain the procedure

  • A stool sample is taken to detect the presence of blood
  • Presence of blood in the stool is always abnormal
  • Three samples are taken over a three-week period
  • Patients do not need to fast or cease medication for this test
  • Patients are easily able to collect stool sample in their own home
  • Check the patient’s understanding
    • “Does everything I have said so far make sense?”
    • “Do you have any questions for me?”


Collecting the sample

Step 1: Prepare

  • Wash hands
  • Place the flushable tissue paper which is provided in the stool screening kit into the toilet
  • Label personal details (name, date of birth, date of sample collection) on stool screening syringes


Step 2: Collect

  • After passing a bowel motion use the sampling stick to collect a sample of faeces no bigger than a grain of rice (this is best done by dragging the stick back and forth through the stool)
  • Place the sampling stick back into the collection tube and ensure to seal tightly
  • Do not open again
  • Wash hands


Step 3: Store and repeat

  • Place the collection vial into the transportation vials
  • Store in the fridge but do not freeze
  • Repeat the process three times over a two-week period


Step 4: Send

  • Place all 3 samples in the zip lock envelope
  • Complete the patient screening checklist form and ensure to fill out personal details
  • Mail samples back to the laboratory or return to the lab as soon as possible (within 24 hours)



  • Results will be mailed out and are expected within two weeks
  • If you receive a negative result this means no blood was found in your stool and as such you do not need to repeat the test for another two years
  • Negative findings do not rule out the possibility of bowel disease so ongoing screening is recommended for all those over the age of 50 or in those patients with a family history of bowel cancer
  • Positive findings should be discussed with your GP and you may be referred to a gastroenterologist for further evaluation including a colonoscopy
  • Advise patients that a positive test result does not mean that they have bowel cancer, it simply means that blood has been detected in the stool which may be due to a range of conditions


Closing the consultation

  • Check the patient’s understanding
  • Let them know that if they develop symptoms in the meantime to talk to their doctor
  • Provide an information leaflet
  • Thank patient
  • Wash hands


Further information

NHS patient information: https://www.nhs.uk/conditions/bowel-cancer-screening/



Andrew Gowland


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